In patients with acute lower gastrointestinal bleeding (ALGIB), colonoscopies performed within 24 hours after hospital admission did not reduce rebleeding or increase stigmata of recent hemorrhage (SRH) compared with colonoscopies performed between 24 to 96 hours after hospital admission, according to a study published in Gastroenterology.

ALGIB is a common condition worldwide, and the bleeding is often severe enough to require blood transfusion and hemostatic intervention. Early colonoscopy is recommended for its diagnosis and treatment, but there is a general concern regarding the efficacy and safety on early colonoscopy. This large, multicenter, randomized, controlled trial  was designed to assess the safety and efficacy of early colonoscopy on outcomes in patients with ALGIB. At 15 hospitals in Japan, 159 patients with ALGIB were randomly assigned to early colonoscopy (<24 hours of initial hospital visit; n=79), or elective colonoscopy (24-96 hours post-admission to hospital; n=80). The primary study outcome was the identification of SRH; secondary outcomes were 30-day rebleeding, success of endoscopic treatment, length of stay, need for transfusion, adverse events, 30-day thrombotic events, and 30-day death.

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In the early colonoscopy group, SRH were identified in 21.5% of patients (17 of 79), compared with 21.3% (17 of 80) in the elective colonoscopy group (difference 0.3; 95% CI, -12.5 to 13.0; P =.967). Central review identified SRH in 25.3% of patients (20 of 79) in the early colonoscopy group and in 26.3% of patients (21 of 80) in the elective colonoscopy group (difference, -0.9; 95% CI, -14.5 to 12.7; P =.893). Thirty-day rebleeding was seen in 15.3% of patients (11 of 72) in the early colonoscopy group and in 6.7% (5 of 75) of patients in the elective colonoscopy group (difference=8.6; 95% CI, -1.4 to 18.7); these findings remained unchanged in the per-protocol analyses.

No significant between-group differences were seen in length of stay, rate of successful endoscopic treatment, thrombotic events, transfusion rate, or death within 30 days. Except for nausea and exacerbation of bleeding, there was a less than 5% rate of colonoscopy- and bowel–preparation-related adverse events in both groups. In the early group, no patients experienced hemorrhagic shock, compared with 2.5% (n=2) in the elective colonoscopy group.


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Study limitations included the inability to complete a direct-blinded patient assessment, the choice of SRH identification, differing numbers of enrolled patients based on location, and a lack of generalizability.

The study investigators concluded that this multicenter randomized controlled trial demonstrated that early colonoscopy, performed within 24 hrs of arrival, did not increase SRH identification rate or reduce rebleeding compared with colonoscopy after 24-96 hours when compared with elective colonoscopy in patients with ALGIB.

 Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Niikura R, Nagata N, Yamada A, et al. Efficacy and safety of early versus elective colonoscopy for acute lower gastrointestinal bleeding [published online September 26, 2019]. Gastroenterology. doi: 10.1053/j.gastro.2019.09.010